Yoga for women in reproductive age
In any community mothers and children constitute a priority group. In sheer numbers, they comprise approximately 70% population of the developing countries. In India women of child bearing age group (15-44 yrs) constitute 19% of total population. By virtue of their numbers, they should be the ideal consumers of health sciences. But unfortunately, the health of Indian
women is intrinsically linked to their status in society. It is said that women enjoyed equal status with men in all fields of life in ancient India. Scriptures such as Rigveda, upanishadas, mention about sages and seers notably Gargi and Maitrayi.
But still today modern woman is fighting for the survival amidst the crisis such as dowry,female infanticide, sex selective abortions, health and domestic violence. This makes a total negative impact on reproductive health of women.
A tremendous stress of work in working women outside the house and inside the house is creating increasing physical and mental burden with increased incidence of menstrual cycle related and psychosomatic problems.
There is increase in the incidence of polycystic ovarian syndrome by almost 40% in adolescent girls. These are alarming figures. In one of study conducted by one NGO, women do more than
67% of the hours of work and earn only 10% of the world’s income. At the same time, 67% of world’s illiterate adults are women. In India child sex ratio has dropped to 927 females per 1000 males in 2001. 92% of women suffer from gynecological problems. In spite of efforts done at personal, social, governmental level, woman all over the world in 21 st century still remains a victim of wrong social customs and attitudes. In spite of all MCH care facilities India remains second highest in world in maternal mortality rates. The woman has little control over her fertility and reproductive health. In short, in our culture even today, the `mainstream’
remains very much a `male stream.’
The female reproductive system consists of external genital and internal reproductive organs. The external genitalia comprise of structures visible externally from the pubis to perineum,
that is, the mons pubis, labia majora and minora, clitoris, hymen, vestibule, urethral opening, and various glandular and vascular structures.
The internal reproductive organs are uterus, oviducts (fallopian tubes), ovaries and vagina.
- Uterus : The size and configuration of uterus undergoes dramatic changes throughout the life.It is a unique organ in that sense. In a girl child uterus is very small and inactive, it increases in size at an age when a girl starts menstruating.
It expands and attains a size of 7-8 cms along long axis, 5 cms broad and 3-4 cms in length during reproductive age and it involutes, shrinks and atrophies after menopause.
Pregnancy provokes an enormous increase in size of uterus to accommodate the growing fetus and other products of conception.
The uterine cavity is triangular in shape. The mucosa of uterine cavity is shed off cyclically every month in the form of menstrual cycle.
The mucosal lining gets replaced every month of there is no conception. It is under the influence of ovarian hormones.
- Cervix : Cervix projects through the wall of vagina. It is 3-4 cms in length. It provides receptivity to sperms for fertilization. It plays an extremely important role at time of parturition.
- Fallopian Tubes : They are two long tubular structures on either side of body of uterus, opening in the endometrial cavity.
The fertilization of egg by sperms occurs in fallopian tubes. But how the fertilized egg (zygote) is transferred into the endometrial cavity is one of the most challenging secrets of nature.
- Ovaries : They are pearly white structures, two in number on either side of uterus under the fallopian tubes. They have an irregular surface with presence of mature or immature follicles on them.Ovaries serve as important endocrine glands secreting estrogen and progesterone hormones.
- Vagina : It is a long Musculo- membranous passage extending from cervix to vulva and it opens on the perineum between the urethra and the anus. It has the ability to expand enormously at
time of birth of baby. It has mucous secreting glands allowing lubrication.
Menstrual Cycle :
The attitudes, opinions, practices and superstitions beliefs about the natural phenomenon of
menstrual cycle make a young adolescent stepping into adulthood feel as if something unwanted has happened in their life. Actually, the rhythmical and harmonic hormonal changes of cyclic nature have made it the most remarkable biologic event in female body.
Menstruation is a periodic and cyclic flow of menstrual blood from the uterus. It is a biologic
process dependant on complex hormonal and physiological changes that can be disturbed by a
variety of factors. (Sheth, Sutton).
The normal cyclicity is 24 to 35 days but it varies with individual women.
Menstrual cycle is an outward and visible sign of the periodic activities of the ovaries. This
point is of clinical importance because; alteration in menstrual rhythm can only be due to a
disturbance of ovarian activity.
Regulation of menstrual cycle is done by signals from hypothalamus and pituitary gland.
“Just as body is casting off substances it doesn’t need any more, so we too can throw off
worn out ideas and self images and make the most of this opportunity for self renewal.”
Says Swamiji Paramahansa Satyananda Saraswati
Epidemiology :
Menstrual disorders are common gynecological problem for medical visits among women of
reproductive age.
- Heavy menstrual bleeding affects up to 30% of women in their reproductive period.
- infertility is a big problem of this age group and According to WHO, the national prevalence of primary and secondary infertility in India is 3 %and 8 % respectively.
- Menstrual problems were noticed in 35.36 per cent of women with almost equal distribution in urban and rural areas.
- The commonest menstrual problem was dysmenorrhea in 27.41 per cent of subjects while it was 25.2 per cent in another study.
Physical problems in various phases of females of reproductive age
In a total span of 30 years of reproductive age of a woman, she is exposed to various changes
in hormones depending on the need at the particular time. Lack of exercise, lack of adequate
sleep, irregular life style , improper food habits are mainly responsible for development of
variety of health issues like PCOS, AUB, hypothyroidism, anaemia, deficiency of vitamins and
many other problems related to digestion and other systems including metabolic syndrome.
Incidence of fibroid uterus, endometriosis ,malignancies is also increasing which demands
urgent attention of health providers.
Polycystic ovarian syndrome
Although first described by Stein and Leventhal in 1935, it is becoming one of the most prevalent life style related multisystem disorder of modern age today. Global prevalence of PCOS is 2.2% to 26%. One in 15 women worldwide, depending on the population studied (Lancet, 2007) suffers from PCOS.
In India, incidence in North India is 3.7% between 18-25yrs . In Mumbai it is around 22.5% for
age group 15-24yrs 2.
PCOS leads to a lot of hormonal problems leading to irregular menses, heavy or scanty menses, growth of unwanted hair, infertility and diabetes.
Abnormal Uterine Bleeding
AUB is reported to occur in 9 to 14% women between menarche and menopause3. The prevalence varies in each country. In India, the reported prevalence of AUB is around 17.9%4 Descriptive terms that have been used to characterize AUB patterns include menorrhagia,
metrorrhagia, polymenorrhagia, dysfunctional uterine bleeding and heavy menstrual bleeding.
To standardize nomenclature of AUB, a new system known by the acronym PLAM-COEIN (Polyp; Adenomyosis; Leiomyoma; Malignancy and Hyperplasia; Coagulopathy; Ovulatory Disorders; Endometrial factors; Iatrogenic; and Not classified) was introduced in 2011 by the
International Federation of Gynecology and Obstetrics
(FIGO)
Since reproductive age represents a major portion of woman`s life, it is important to understand the dietary needs in different phases of reproductive age. The needs of recommended nutritional considerations would vary depending on physical activity ,age,gravid or non-gravid state, lactating or non-lactating mother.
On one hand we have the problem of mal nutrition with deficiency of iron and vitamins in
developing countries ,on the other hand obesity is becoming an epidemic.
Both these extremes can have adverse effects on menstrual cycle ,outcome of pregnancy.
Apart from balanced diet with adequate proteins,carbohydrates,fats,vitamins ,minerals ,fiber
and water yogic literature describes diet full of Trigunas i.e. tamasik, rajasik, satwik diet. Diet
has to be satwik, seemit i.e. in moderate quantity, santulit i.e. balanced.
Food according to yoga not only forms the body but is also responsible for kriyashakti and manashakti.
- Diet of mind is equally important. Give good food for thought, avoid mental or emotional excitation while eating, do not curse the food you are eating.
- Always pray before starting.
- Do not watch TV ,enter into controversies, or read when you are enjoying food.
Yoga module for pregnancy Common for all trimesters
- SEQUENCE OF DAILY PRACTICE
- Any comfortable posture For beginning with ! tratak
- E.g. Sukhasan, ardha Padmasana, Padmasana vajrasana
- Mudra to be practised _ Drona , Jnana, dhyana
- PRAYERS
- LOOSENING PRACTICES
- Padanguli Namana / Gulpha namana
- Gulpha Chakra
- Gulpha Ghurnana
- Janu Namana
- Janu Cakra
- Ardha Titali Asana
- Shroni Chakra
- Mustika bandhana
- Mani bandha Chakra
- Kehuni Namana
- Skandha chakra
- Greeva Sancalana
Co-relation of these movements is to be done with inhalation / exhalation.
Practicing Asanas
- Dehasadhana : Sitting
Vajrasana, Marjarasana, Mandukasana, Hanumantasana, Sulabha ushtrasana, bhadrasana, Sulabha parvatasana, Vrushabhasana
- Dehasadhana : Standing
Sulabha chakrasana, Utkatasana
- Supine
Sulabha Uttthit ekpadasana, Vamangasana, Setubandhasana, Anantasana, Uttana
vakrasana, Uttana bhadrasana, Shavasana
- Mudra
Brahma mudra, Simha mudra, Jnana mudra, Dhyana mudra, Namana mudra
- Cleansing Practices
Kunjal kriya, Jyoti trataka
- Pranasadhana
Deep breathing, Yogic breathing, Anuloma viloma, Bhramari, Sheetali, Seetkari
- Bhava Sadhana
Om chanting, Devotional songs, Mantra, Japa
- Divya sadhana
Pratyahara, Dharana, Dhyana,
Some advice on diet and counseling are also equally important.
Specification in pregnancy
- First Trimester : May practice Vamana or Kunjal Kriya for excessive vomiting Sheetali, Sitkari Pranayama to reduce nausea.
- Second trimester : Practice asanas pranayama, ! kar relaxation maximum.
- Third trimester More simple practices, focus more on bhava sadhana.
e.g. kar chanting, Devotional songs, etc.
- Intrapartum i.e. at time of delivery : Practice Abdominal breathing, ! kar chanting,
in between labour pains / contractions.
- Post partum i.e. after delivery : To resume all practices as soon as possible.
Practices for menstrual disorderds /PCOD
- To start with Trataka on ! in any confortable body posture. Kapalbhati 25 - 50 rounds
- Prayers
- Loosening Practices
- Padanguli Namana / Gulpha namana
- Gulpha Chakra
- Gulpha Ghurnana
- Janu Namana
- Janu Cakra
- Ardha Titali Asana
- Shroni Chakra
- Purna Titali a sana
- Mustika bandhana
- Mani bandha Namana
- Mani bandha Chakra
- Kehuni Namana
- Skandha chakra
- Greeva Sancalana
- Chakki chalan
Followed by Surya Namaskars minimum 12, associated with breathing .
Practicing asanas
- Asanas in sitting position
- Vajrasana
- Parvatasana
- Marjara sana
- Yoga mudra
- Ushtrasana
- Bhusirasana
- Shirsasana
- Asanas in Supine position
- Utthita ekapadasana
- Utthita twipadasana
- Viparita Karani mudra
- Sarvangasana
- Tadagi mudra
- Uttana Vakrasana
- Asanas in Prone position
- Bhujangasana
- Salabhasana
- Naukasana
- Dhanurasana
- Asanas in Standing Position
- Chakrasana
- Ekapada Tolasana
- Vakrasana
- Hastapadasana
- Pranayama : Anuloma Viloma (All to be Practised with abdominal) Sheelali, Seetkari breathing, Bhramari
- Yoga nidra everyday - Mandatory.
Module for menopause :
- Surya namaskars as per capacity.
- Focus intensely and more on pratyanara, Phavana, Dhyana
- Practice of devotional songs, Naad yoga
To start with Trataka on in any comfortable body posture and prayers, Kapalbhati as per capacity.
Loosening Practices:-
- Padanguli Namana / Gulpha Namana
- Gulpha Chakra
- Gulpha Ghurnana
- Janu Namana
- Janu Chakra
- Ardha Titali Asana
- Shroni Chakra
- Purna Titali Asana
- Mustika Bandhana
- Mani Bandha Namana
- Mani Bandha Chakra
- Kehuni Namana
- Skandha Chakra
- Greeva Sancalana
- Chakki Chalan
From inside the womb, till her death, a woman is always faced with danger. In the womb, the chances of being killed, even before seeing light, when being born and growing, she faces harsh brutalities like molestation, abusing, physical and mental tortures.
The gender bias and social stigmaIn the traditional society the inequality between males and females existed to a large extent.Women were looked down socially, economically and politically. Women became scape goats of many traditions and customs. She was brutally killed in the name of Sathi. Women`s role was restricted to domestic life especially kitchen work and bearing and rearing of children. She has no place in economic and political activities. Girl children were discriminated in terms of basic necessities of life such as food, clothing and shelter.
Empowering women regarding the own re-productive health care is extremely important and has been taken up by government as priority. c But still women continue to suffer from many social and economic disadvantages since the attitudes did not change as fast as the change in laws. We need a change in mindset in terms of attitudes and behavior of both men and women of all dimensions.
Role of counseling and proper education to females of reproductive ageCounseling plays an extremely important role in the management of various diseases.
The role of counselor is to be empathetic and not sympathetic. A good yoga instructor should try to be a good listener. It is important to remove all mis concepts about yoga as therapy ,at the same time to try and build confidence in the mind of the beneficiary is a skill to talk and find out the root cause of trouble. Counselling should be helpful to vent out negativity and build positivity.
Releasing stress itself doubles the benefit of practices.
Pregnancy-a special conditionPregnancy is a unique time in a woman’s life wherein it is of prime importance that various dimensions of her being are in harmony.
Though pregnancy and childbirth are not unnatural events, the physical, mental and emotional adaptive changes in body largely determine her good health and a positive outcome of pregnancy. The normal growth of fetus can be affected by a number of factors such as PIH, or even psychosomatic stress.
It is known that hypothalamus-pituitary-adrenal axis (HPA) reacts to sustained stress. This affects the uterine circulation in turn decreasing the blood flow reaching the decidua affecting the implantation site. Stress makes a woman abortion prone, as well as other medical complications of pregnancy. Pregnant women were also advised by Hippocrates to beware of unnecessary psychic stress Psychological and physical stress have seldom been formally studied but seem intuitively important says William’s textbook of obstetrics.
Maternal stress reacts to sustained stress (HPA axis) resulting in endocrine disturbances, repeated abortions, pregnancy induced hypertension, anxiety and functional impairment,immune maladaptation, premature delivery, small for gestational age fetus and post-partum depression. (Tracey teal Med Sci sports Exerc 36 (12): 2024-2031, 2004. , Williams Obstetrics,twenty second edition p 178, 859, 1241, Shaman kamani J of Indian Medical Association: JIMA Vol 103 No. 11 Jan 2005).